Sleeve Gastrectomy is a surgery where the stomach is narrowed longitudinally. This narrowing procedure can be referred to by various names.

Other names for Sleeve Gastrectomy:

• Tube Stomach

• Stomach Tubing

• Gastric Sleeve

• Vertical Sleeve Gastrectomy

• Greater Curvature Gastrectomy

• Parietal Gastrectomy

• Stomach Reduction

• Vertical Gastroplasty

In the surgical treatment of obesity, weight loss is achieved through two main methods. The first one aims to reduce the amount of food consumed, which is done by reducing the stomach volume. The second one focuses on reducing the absorption of the food, by closing part of the small intestine in various lengths. Sleeve Gastrectomy is a procedure done to reduce only the stomach's volume. Part of the stomach is removed by making a longitudinal incision, resulting in a smaller stomach with the shape of a slim banana. This is why it is also referred to as a "tube stomach."

In the Sleeve Gastrectomy procedure, the most expandable part of the stomach, which increases its volume, is removed. The remaining part of the stomach does not expand as much, thus preventing excessive eating.

The tubing of the stomach also increases its resistance to food. Large amounts of food are not allowed to pass through the stomach. The stomach's rapid emptying ensures that food doesn't stay in the stomach long enough to expand it.

This procedure leads to faster passage of food to the small intestine, stimulating its movement. Although Sleeve Gastrectomy does not change the small intestine, it prevents excessive calorie absorption.

The procedure has evolved over time. Initially, the stomach was simply closed longitudinally, but later, the closed part of the stomach began to be removed. The technique was first used by Dr. Jamieson from Australia in 1993 and by Dr. Johnston from the UK in 1996. In 2001, Dr. Gagner from the US published the procedure of removing part of the stomach, which made it a viable first step in the treatment of super obese patients. Since then, the Sleeve Gastrectomy has become increasingly popular, and today it is often used as an alternative to gastric band surgery for patients with lower BMI.

Who Can Have Sleeve Gastrectomy?

• It can be applied to all patients who need treatment for obesity.

• It is commonly applied to super obese patients with a BMI over 50 kg/m² as the first step of treatment.

• For patients who are reluctant to undergo other gastric bypass surgeries due to long-term complications, Sleeve Gastrectomy is an option.

• It is an alternative to gastric banding for patients planning to have this surgery.

• For those who experience issues with gastric bands, Sleeve Gastrectomy can be performed after removing the band.

• Sleeve Gastrectomy is often used for patients who do not want foreign objects like a gastric band or do not wish to undergo adjustments after the surgery.

What are the Risks of Sleeve Gastrectomy?

• The procedure involves removing part of the stomach, leaving a suture line. In some cases, small leaks may occur from the suture line. This risk is less than 1% and most leaks heal without intervention. In rare cases, abscesses may develop, requiring drainage and antibiotic treatment.

• Causes for these leaks can be related to surgical techniques or patient-specific issues such as obesity-related immune system weaknesses, which may delay healing.

• Modern surgical techniques have greatly minimized these risks, and both pre- and post-operative care ensure that these issues are rare and manageable.

How is Sleeve Gastrectomy Performed?

• Like other obesity and metabolic surgeries, Sleeve Gastrectomy is done using a laparoscopic (closed) technique. Small incisions are made in the abdomen, and special instruments are used to perform the surgery. These instruments cut and stitch the stomach. After surgery, patients can drink water on the same day, and bowel movements often return to normal the following day.

What are the Advantages of Sleeve Gastrectomy?

• Can be performed laparoscopically, meaning faster recovery, less pain, and shorter hospital stay.

• Reduces stomach capacity without changing its function, allowing smaller portions of most food groups to be consumed.

• Reduces hunger by removing the part of the stomach that produces ghrelin (the hunger hormone), leading to weight loss.

• The pylorus (stomach valve) is preserved, preventing dumping syndrome, and food stays in the stomach longer, enhancing the feeling of fullness.

• Reduces the risk of ulcers.

• No bypass of the intestines, so it avoids complications like intestinal blockages, marginal ulcers, anemia, osteoporosis, and nutrient deficiencies.

• Highly effective for patients with very high BMI (>55 kg/m²) as the first-step surgery.

• Ideal for patients concerned about the long-term complications of bowel bypass or those with conditions like Crohn's disease.

• Less invasive, meaning fewer wounds, less lung issues, less pain, and faster recovery.